Prognostic impact of body mass index on in-hospital bleeding complications after ST-segment elevation myocardial infarction

BACKGROUND ST-elevation myocardial infarction(STEMI)remains a major cause of mortality despite early revascularization and optimal medical therapy.Tailoring individual management by considering patients’specificities may help in improving post-STEMI survival.AIM To evaluate whether in-hospital bleeding complications may be involved in post STEMI prognosis among overweight patients.METHODS We prospectively included 2070 patients with a STEMI between January 2005 and December 2012 in the French observational cohort,“Registre d’Infarctus Maine-Anjou”.Bleeding Academic Research Consortium(BARC)in-hospital bleeding complications were recorded.RESULTS Of 705 patients(35.3%)were presented as being of normal weight,defined as a body mass index(BMI)<25 kg/m^2,877(43.9%)had a BMI between 25 and 30 kg/m^2and 416(20.8%)had a BMI≥30 kg/m^2.One-year cardiovascular mortality was lower for BMI≥25 kg/m^2(5.3%and 7.1%)patients than for normal weight patients(10.8%)(P=0.001).We found an interaction between the effect of BARC 3 on mortality and BMI groups.While a BARC 3 was related to a higher 1-year mortality in general(HR:2.58,95%CI:1.44-4.64,P≤0.001),prognosis was even worse in normal weight patients(HR:2.97,95%CI:1.61-5.5,P<0.001)than for patients with a BMI≥25 kg/m^2(HR:1.94,95%CI:1.02-3.69,P=0.041).CONCLUSION Normal weight patients presented higher rates of in-hospital bleeding complications and lower survival after a STEMI.Excess mortality might be due to greater vulnerability to bleeding amongst normal weight patients.

Bleeding complications after percutaneous kidney biopsies–nationwide experience from Brunei Darussalam

BACKGROUND Kidney biopsy serves as a valuable method for both diagnosing and monitoring kidney conditions.Various studies have identified several risk factors associated with bleeding complications following the procedure,but these findings have shown inconsistency and variation.AIM To investigate the risk of bleeding complications following percutaneous kidney biopsy in Brunei Darussalam.We sought to explore the relevant clinical and pathological risk factors associated with these complications while also considering the findings within the broader international literature context.METHODS We conducted a retrospective study of all adult patients who underwent kidney biopsy in Brunei Darussalam from October 2013 to September 2020.The outcomes of interest were post-biopsy bleeding and the need for blood transfusions.Demographics,clinical,laboratory and procedural-related data were collected.Logistic regression analysis was used to identify predictors of outcomes.RESULTS A total of 255 kidney biopsies were included,with 11%being performed on transplanted kidneys.The majority of biopsies were done under ultrasound guidance(83.1%),with the rest under computer tomography guidance(16.9%).The most common indications for biopsy were chronic kidney disease of undefined cause(36.1%),nephrotic syndrome(24.3%)and acute kidney injury(11%).Rate of bleeding complication was 6.3%–2%frank hematuria and 4.3%perinephric hematoma.Blood transfusion was required in 2.8%of patients.No patient lost a kidney or died because of the biopsy.Multivariate logistic regression identified baseline hemoglobin[odds ratio(OR):4.11;95%confidence interval(95%CI):1.12-15.1;P=0.03 for hemoglobin≤11 g/dL vs.>11 g/dL)and the presence of microscopic hematuria(OR:5.24;95%CI:1.43-19.1;P=0.01)as independent risk factors for post-biopsy bleeding.Furthermore,low baseline platelet count was identified as the dominant risk factor for requiring postbiopsy transfusions.Specifically,each 10109/L decrease in baseline platelet count was associated with an 12%increase risk of needing transfusion(OR:0.88;95%CI:0.79-0.98;P=0.02).CONCLUSION Kidney biopsies were generally well-tolerated.The identified risk factors for bleeding and transfusion can help clinicians to better identify patients who may be at increased risk for these outcomes and to provide appropriate monitoring and management.

A novel role of chitosan in reducing vascular access bleeding complications after transradial angiography

To investigate the safety and efficacy of chitosan ( Anscare,Daxon) in reducing vascular ac cess complications compared to a kind of radial compression device( TR-BAND,Terumo) . Method: We studied 128 patients who had undergone transradial angiography in our center from December 2009 to April 2010. Among them,64 patients were randomly treated with radial compression device ( TR-BAND,Terumo) when the procedure was over ( CD group) . The other 64 patients were dealt with chitosan ( CS group) . The compression time,the major and minor access site bleeding complications and the errhysis were observed. Results: There were no statistical differences in the baseline clinical characteristics of the patients between two groups. The compression time in CS group was significantly shorter than that of CD group ( P < 0. 001) . There were 12 patients suffering from minor access site bleeding while only 3 patients experienced these minor complications in CS group( 19% vs 4% ,P < 0. 05) . At the same time 20 patients had er- rhysis in CD group and 4 patients in CS group ( 31% vs 6% ,P < 0. 001) . Conclusion: Chitosan,compared to radial compression device ( TR-BAND,Terumo) ,can not only shorten the compression time,but also significantly reduce the rate of minor access site bleeding and puncture-site errhyis.

Impact of laparoscopic liver resection on bleeding complications in patients receiving antithrombotics

To assess the impact of laparoscopic liver resection (LLR) on surgical blood loss (SBL), especially in patients with antithrombotics for thromboembolic risks. METHODSConsecutive 258 patients receiving liver resection at our institution between 2010 and 2016 were retrospectively reviewed. Preoperative antithrombotic therapy (ATT; antiplatelets and/or anticoagulation) was regularly used in 100 patients (ATT group, 38.8%) whereas not used in 158 (non-ATT group, 61.2%). Our perioperative management of high thromboembolic risk patients included maintenance of preoperative aspirin monotherapy for patients with antiplatelet therapy and bridging heparin for patients with anticoagulation. In both ATT and non-ATT groups, outcome variables of patients undergoing LLR were compared with those of patients receiving open liver resection (OLR), and the independent risk factors for increased SBL were determined by multivariate analysis. RESULTSThis series included 77 LLR and 181 OLR. There were 3 thromboembolic events (1.2%) in a whole cohort, whereas increased SBL (≥ 500 mL) and postoperative bleeding complications (BCs) occurred in 66 patients (25.6%) and 8 (3.1%), respectively. Both in the ATT and non-ATT groups, LLR was significantly related to reduced SBL and low incidence of BCs, although LLR was less performed as anatomical resection. Multivariate analysis showed that anatomical liver resection was the most significant risk factor for increased SBL [risk ratio (RR) = 6.54, P < 0.001] in the whole cohort, and LLR also had the significant negative impact (RR = 1/10.0, P < 0.001). The same effects of anatomical resection (RR = 15.77, P < 0.001) and LLR (RR = 1/5.88, P = 0.019) were observed when analyzing the patients in the ATT group. CONCLUSIONLLR using the two-surgeon technique is feasible and safely performed even in the ATT-burdened patients with thromboembolic risks. Independent from the extent of liver resection, LLR is significantly associated with reduced SBL, both in the ATT and non-ATT groups.

Infliximab stopped severe gastrointestinal bleeding in Crohn's disease

To report the result of rapid ulcer healing by infliximab in Crohn's patients with severe enterocolic bleeding. During 2005 and 2010, inflammatory bowel disease database of King Chulalongkorn Memorial and Samitivej hospitals were reviewed. There were seven Crohn's disease (CD) patients (4 women and 3 men; mean age 52 ± 10.4 years; range: 11-86 years). Two of the seven patients developed severe gastrointestinal bleeding (GIB) as a flare up of CD whereas the other five patients presented with GIB as their first symptom for CD. Their mean hemoglobin level dropped from 12 ± 1.3 g/ dL to 8.7 ± 1.3 g/dL in a 3-d period. Median packed red blood cells units needed for resuscitation was 4 units. Because of uncontrolled bleeding, surgical resection was considered. However, due to the poor surgical candidacy of these patients (n = 3) and /or possible development of short bowel syndrome (n = 6), surgery was not pursued. Likewise angiographic embolization was not considered in any due to the risk of large infarction. All severe GIBs successfully stopped by one or two doses of intravenous infliximab. Our data suggests that infliximab is an alternative therapy for CD with severe GIB when surgery has limitation or patient is a high risk.

Safety of laparoscopic surgery in digestive diseases with special reference to antithrombotic therapy: A systematic review of the literature

AIMTo elucidate the effect of antithrombotic therapy （ATT） on bleeding and thromboembolic complications during or after laparoscopic digestive surgery.METHODSPublished articles or internationally accepted abstracts between 2000 and 2017 were searched from PubMed, Cochrane Database, and Google Scholar, and studies involving laparoscopic digestive surgery and antiplatelet therapy （APT） and/or anticoagulation therapy （ACT） were included after careful review of each study. Data such as study design, type of surgical procedures, antithrombotic drugs used, and surgical outcome （both bleeding and thromboembolic complications） were extracted from each study.RESULTSThirteen published articles and two internationally accepted abstracts were eligible for inclusion in the systematic review. Only one study concerning elective laparoscopic cholecystectomy in patients with peri-operative heparin bridging for ACT showed that the risk of postoperative bleeding was higher compared with those without ACT. The remaining 14 studies reported no signifcant differences in the incidence of bleeding complications between the ATT group and the group without ATT. The risk of thromboembolic events （TE） associated with laparoscopic digestive surgery in patients receiving ATT was not signifcantly higher than those with no ATT or interrupted APT.Fujikawa T et al . Laparoscopic digestive surgery and antithrombotic therapyCONCLUSIONLaparoscopic digestive surgery in ATT-burdened patients for prevention of bleeding and TE showed satisfactory results. The risk of hemorrhagic complication during or after these procedures in patients with continued APT or heparin bridging was not signifcantly higher than in patients with no ATT or interrupted APT.

Safety of liver resection in patients receiving antithrombotic therapy:A systematic review of the literature

BACKGROUND Little is unknown about the effect of chronic antithrombotic therapy(ATT)on bleeding complication during or after hepatectomy.In addition,the safety and effectiveness of chemical prevention for venous thromboembolism(VTE)is still controversial.AIM To clarify the effect of ATT on thromboembolism and bleeding after liver resection.METHODS Articles published between 2011 and 2020 were searched from Google Scholar and PubMed,and after careful reviewing of all studies,studies concerning ATT and liver resection were included.Data such as study design,type of surgery,type of antithrombotic agents,and surgical outcome were extracted from the studies.RESULTS Sixteen published articles,including a total of 8300 patients who underwent hepatectomy,were eligible for inclusion in the current review.All studies regarding patients undergoing chronic ATT showed that hepatectomy can be performed safely,and three studies have also shown the safety and efficacy of preoperative continuation of aspirin.Regarding chemical prevention for VTE,some studies have shown a potentially high risk of bleeding complications in patients undergoing chemical thromboprophylaxis;however,its efficacy against VTE has not been shown statistically,especially among Asian patients.CONCLUSION Hepatectomy in patients with chronic ATT can be performed safely without increasing the incidence of bleeding complications,but the safety and effectiveness of chemical thromboprophylaxis against VTE during liver resection is still controversial,especially in the Asian population.Establishing a clear protocol or guideline requires further research using reliable studies with good design.